Mark Dombeck, Ph.D. Updated: Oct 25th 2005
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1. is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
2. shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
3. is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
4. is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
5. is unable to discard worn-out or worthless objects even when they have no sentimental value
6. is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
7. adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
8. shows rigidity and stubbornness
Cynthia Levin, Psy.D. Updated: Oct 25th 2005
Personality disorders are typically some of the most challenging mental disorders to treat, since they are, by definition, an integral part of what defines an individual and their self-perceptions. Treatment most often focuses on increasing coping skills and interpersonal relationship skills through psychotherapy.
Individuals who suffer from this personality disorder often are characterized by their lack of openness and flexibility in not only their daily routines, but also with interpersonal relationships and expectations. The overwhelming preoccupation with orderliness, perfectionism and control of their lives and relationships means that most types of treatment are going to be, at best, difficult. Treatment options that do not fit within the client's cognitive schema will likely be quickly rejected rather than attempted.
Individuals who suffer from this disorder have difficulty in incorporating new and changing information into their lives, so new learning takes place only over a great deal of time and with as much effort on both the clinician's and client's part. Their ability to work with others is equally affected, since they see the world as black and white -- their way of doing things and the wrong way of doing things. Naturally, this faulty logic will also be translated into their therapeutic relationship with the clinician and their treatment. It is therefore unlikely the clinician will have much success in using techniques or treatment modalities, which haven't first been approved by the patient for use. Sometimes, simply stating the effectiveness of a given treatment for a specific problem citing relevant research studies may help the patient be more open to certain treatments. More often, though, this technique won't be effective.
When this disorder is combined with the presentation of a medical illness, physicians should expect a logical and coherent presentation of troubling symptoms with little emotionality attached to their physical discomfort. Treatment is most effective when the nature of the disease process is first discussed with the individual, as well as typical and accepted treatments. A physician in this instance is best sticking with the facts of the presenting problem and underlying disorder rather than offering vague impressions of their opinion. Since the individual with this disorder tends to be meticulous and concerned with details, the treatment regimen -- once accepted -- will likely be adhered to rigorously, without incident.
As with most personality disorders, individuals seek treatment for items in their life that have become overwhelming to their existing coping skills. These skills may be somewhat limited, in the first place, because of their disorder. While they may be generally effective enough in most instances to shield the client from stress and emotional difficulties, during times of increased stress, work pressure, family problems, etc. the underlying disorder will become more evident in day-to-day behaviors. As with most personality disorders, treatment is often focused on short-term symptom relief and the support of existing coping mechanisms while teaching new ones. Long-term or substantive work on personality change is usually beyond most clinician's skill levels, and patient's budgets. Obsessive-compulsive personality disorder is especially resistant to such changes, because of the basic makeup of this disorder.
Short-term therapy will most likely be beneficial when the patient's current support system and coping skills are examined. Those skills that are not currently working could be reinforced with additional skill sets. Social relationships can also be examined, reinforcing strong, positive relationships while having the client re-examine negative or harmful relationships. One important aspect is to try and have the individual examine and properly identify their feeling states, rather than just intellectualizing or distancing themselves from their emotions. This can be accomplished through a variety of techniques, such as feeling identification (e.g., the "feeling faces") at the onset of every therapy session. Homework might include writing feelings down in a journal, especially as they notice them. Proper identification and realization of feelings can bring about much change in and of itself.
Individuals suffering from obsessive-compulsive personality disorder often are not in touch with their emotional states as much as their thoughts. Leading the client away from describing situations, events, and daily happenings and to talking about how such situations, events and daily happenings made them feel may be helpful. Sometimes the patient may complain he or she doesn't remember or know how he or she felt at the time; the journal becomes a useful tool at this point.
Therapy with people who have this disorder can sometimes be trying, since they can see the world in a very "all-or-nothing" manner. Beck's cognitive therapy doesn't seem to be all that effective in treatment, and cognitive approaches in general probably aren't useful in this case. Clinicians must be willing to undergo verbal attacks on their professionalism and knowledge, as such skepticism about a therapist's treatment approach from the client with this disorder can be expected. Clinicians should also be careful about engaging the client within these verbal attacks or intellectual discussions, as they continue to distance the patient from his or her feelings, and take the focus off of the client and onto unrelated matters (e.g., a therapist's professional training).
Most people who suffer from this personality disorder (and the different, but related, obsessive-compulsive disorder) lead relatively normal lives, may have a family, friends, and work regularly. Clinicians should be careful not to overgeneralize psychopathology and look to change aspects of the patient's personality he or she is not ready or willing to change. This means, in effect, that if the way they relate to others in their environment (which a clinician might characterize as a personality disorder) is working for them, a clinician should not seek to change it 180 degrees without the client's purposeful consent. Therapy will most often be most effective when it focuses on correcting short-term difficulties currently being experienced. It will become increasingly less effective when the goal of therapy is complex, long-term personality change.
Although a group therapy modality may be helpful and an effective treatment option, most people who suffer from this disorder will not be able to withstand the minimum social contact necessary to gain a healthy group dynamic. They may quickly become ostracized by the group for pointing out other people's deficits and "wrong-headed" ways of doing things.
Hospitalization is rarely needed for people who suffer from this disorder, unless an extreme or severe stressor or stressful life event occurs which increases the compulsive behaviors to an extent where regular daily activities are halted or present possible risks of harm to the patient. Hospitalization may also be needed when the obsessive thoughts do not allow the individual to conduct any usual activities, paralyzing them in bed or with their accompanying compulsive behaviors.
Medication for this disorder is generally not indicated unless the individual is also suffering from an associated psychological disorder such as anxiety or depression.
The medical profession often overlooks self-help methods for the treatment of this disorder because very few professionals are involved in them. Support groups, though, offer an excellent adjunct to continuing medication check-ups once a month, and a way to gain emotional and social support through the community. These groups also allow others to ensure the client is doing well and promotes the client's independence and stability. Many support groups exist within communities throughout the world that are devoted to helping individuals with this disorder share their commons experiences and feelings.
Such support groups are recommended to individuals suffering from this disorder, especially if they have found therapy unhelpful or too expensive.
Portions are from Internet Mental Health, by Phillip W. Long, M.D.